BackgroundAt the end of April 2011, my husband and I adopted a disabled kitten (Artie) from our local Humane Society shelter. Artie was 8 months old and had been at the shelter for 5 months. His left front leg was permanently bent at the elbow. We were told that Artie had most likely broken that leg before being brought to the shelter and the bone didn’t reset properly. Since Artie’s right front leg is a normal length leg, he walked hunched over and used his left elbow (instead of paw) to walk on. He had the energy level of a normal kitten, though, and enjoyed playing with the other kittens at the shelter. After examining Artie and his paperwork, our veterinarian (Dr. Kraft) said that Artie had most likely been hit by a car (he had scratches on his face when he was brought to the shelter, and still has a scar on his lip).

Dr. Kraft told us to watch for sores, which could develop into an infection. He said that Artie might eventually need his left arm amputated; we would need to wait and see how he got around and if any sores developed. Before adopting Artie, I tried to research Artie’s condition on the Internet but didn’t find much information specific to his situation. On a cat health forum, I asked if any other cat owners had experience with cats with similar conditions and what type of accommodations we should provide. We followed the advice of several people who suggested placing blankets and thick rugs in front of areas that Artie would jump down from.

Decision to AmputateArtie developed swelling above and below his left elbow in the beginning of June 2011. Dr. Kraft said there wasn’t a safe medication to use in cats to reduce that type of swelling (one used previously has been found to cause kidney failure). He said he could lance the swollen area but that might create an opportunity for infection and the swelling would most likely re-occur fairly soon. We decided against lancing that area. He advised us to apply a cold towel (towel wrapped around cool pack from refrigerator [not freezer]) to the area for 10 minutes at a time, as often as Artie would permit. Unfortunately, Artie was a very active kitten and would not stay still for long periods of time. The other option would have been to keep him in a cage until the swelling went down (7-10 days), but Dr. Kraft agreed that as soon as Artie was released and resumed normal activity, the swelling cycle would most likely start up again. He warned us again to watch for sores, which might lead to infection.

For the next month, we used the cool packs but the swelling stayed at about the same level. When a sore developed on the area in early July, Dr. Kraft advised us that he could give us medicine to treat the infection but, as with the swelling, it would most likely re-occur. He suspected that Artie didn’t have any problems with his arm at the shelter because he’d been restricted to a fairly small cage for the entire time. We discussed amputation as the only permanent way of ending the cycle of swelling/sores/infection. My husband and I didn’t want to prolong Artie’s discomfort, so we decided during that Thursday appointment to have his arm amputated as soon as possible (the following Monday). We also hoped, since the amputation was taking place at such a young age, that it would be more of a non-issue than if we waited a couple of years (although I don’t think the swelling/infection cycle could have continued for a few years anyway).

Even though I knew it was in Artie’s best interest, I still felt horrible that we were having his arm amputated and felt like we had failed him in a major way. I felt a tiny bit better when Dr. Kraft said he suspected from day 1 that the leg would need to be amputated and was surprised that it had held up for as long as it had. Dr. Kraft had performed numerous amputations on both cats and dogs, and he assured us that they all recovered and adjusted to three legs without any problems. He planned on performing a forequarter removal (the left leg and shoulder would both be removed). Artie would remain at the vet clinic the night of his amputation so they could monitor his condition and keep him on a pain drip. We were instructed not to give Artie any food after 8 pm on the night before his surgery. I asked Dr. Kraft if we would need to keep Artie isolated after the surgery. He advised us to keep Artie in a large crate (the type made for large dog breeds) until his stitches were removed (10-day period).

Amputation ResearchI was able to acquire quite a bit of information on the Internet regarding amputation in cats. The information I found most helpful, though, was stories and pictures from actual cat owners (the medical sites were pretty standard and dealt more with the operation itself). Almost all of the amputation stories that I read had positive outcomes. I only remember reading about one family with a negative experience (the amputation turned out fine but that cat still had phantom pain for a couple of years after the amputation). Some interesting information I found on differences between front vs. rear leg amputations: rear leg amputees have more problems jumping up while front leg amputees have more problems jumping down. Also, I read that front leg amputations can be a harder recovery because cats tend to rest their weight more on the front legs. I think that Artie was “fortunate” to have a disabled leg prior to his amputation (versus cats that have amputations because of cancer or being hit by a vehicle). Since Artie had been disabled for much of his life, he learned to do the majority of his walking on his other three legs.

Amputation SurgeryWe dropped Artie off at the vet clinic on Monday at 8 am. The clinic promised to call me later that afternoon to update me on Artie’s status. I was surprised to receive a call from Dr. Kraft later that morning. After having a chance to observe Artie further, he noticed that Artie was an extremely active kitten. Dr. Kraft said that really active cats have the tendency to bump the brachial plexus, which is full of nerves and lacks protection after a forequarter removal. This can cause quite a bit of pain. Instead of a forequarter removal, Dr. Kraft suggested removing the leg up to the area between the shoulder and elbow, which would leave a small stump (less than one inch long).

I agreed with his decision but was worried that I might not be considering potential problems. I’d been expecting a full removal, so I hadn’t researched the pros and cons vs. full or partial removal. The brief information I did find advised not leaving a stump behind (because problems could develop if the animal tried to use it). Dr. Kraft said that there would not be enough of a stump for Artie to use (and he was right—it is much too small to walk on and Artie has never tried). A vet tech called me later that afternoon to let me know that the surgery had been a success, and Artie was awake and “making biscuits with his one paw” (she said it might be the drugs). Since the vet said he’d prefer that Artie be confined for the 10 days before his stitches were removed, we set up a large crate and tried to make it as cozy as possible with a padded cat bed and fluffy blanket, his favorite ratty old green towel (clean!), the stuffed sardine and rat that Artie likes to alternately attack and snug (when he sleeps), and a small litter box. We referred to the cage as Artie’s “recovery condo” after reading about another feline amputee’s experience in her “recovery condo.”

Post-Amputation CareWe picked Artie up the following morning after his surgery. Dr. Kraft told us that Artie had been very squirmy the previous night and pulled out his catheter every 45 minutes. Dr. Kraft stayed at the clinic until 8:30 pm when Artie finally crashed. He said that Artie had used the litter box and walked around his cage. When I first saw Artie, I was surprised that he was already hopping around on his three legs (though fairly wobbly) and that the amputation site didn’t look that bad (similar to a female cat’s stomach after being spayed: shaved area with incision/stitches in the middle). During my online research on amputation, I was able to see pictures of several cats after they were brought home from surgery. I think seeing these pictures helped prepare me for what to expect. When I first saw a picture of a cat after amputation, it was a bit shocking; but after two, three, four, not so much. Dr. Kraft pointed out some swelling near the amputation site (by his armpit) and said we should bring him in if the swelling increased.

Artie was supposed to wear a cape around his neck for 10 days to prevent him from messing with the stitches. He immediately HATED the cape. I read online about other people using baby shirts instead of the capes/cones, and Dr. Kraft gave his okay on using these. I went out and bought a pack of onesies for newborns. I cut off the bottom part, and tried it on Artie. He was much happier with it than the cape. Artie was 8.5 pounds at that time. The larger size (0-3 months) might have worked better for the armhole, which sits slightly high on Artie; but the neck on the 0-3 months would probably be too loose (which would allow him to lick his stitches). After the initial fitting, I cut off the sleeve that his arm slipped into (so that side was like a tank top), which solved the high armhole problem. Then I sewed up the sleeve that covered his amputation site (so he couldn’t get to the stitches). I changed the onesies twice a day (just to make sure that area stayed clean). Artie never had any leakage from the amputation site, but it helped ease my fears of a possible infection. Unfortunately, onesies probably wouldn’t work for cats with rear-leg amputations (because they would still be able to access that area).

Artie was given oral pain medication (Buprenex) in pre-measured syringes twice a day and an antibiotic (pill that we placed a pill pocket). We were authorized to give the pain meds 3x/day if needed, but we never needed to give it to Artie more than 2x/day. He considered the pill pocket a treat and, for the first couple of days, acted like the pain meds were milkshakes (though he later lost his excitement for the pain meds, he was still pretty easy to dose).

Artie was very easy going about everything (onesies, cage, medications, etc). I am lucky enough to freelance from home, so I was able to monitor Artie throughout the 10 days. As much as possible, I worked in Artie’s room and I would let him out of his cage for short periods of time to get used to his three legs. Artie never exhibited any signs of pain. He was also very alert, despite being on pain medication. A friend, whose cat had a rear leg amputated, saw pictures of Artie and commented that her cat was “out of it” almost the entire time she was on the pain meds (Torbutol). Artie remained his usual playful self (wrestling in his cage with his stuffed rat)! For the first two days home, his walk was still a bit unsteady and he would stumble, which made me nervous, but I knew that it was a necessary part of the learning process. He was able to use his litter box without any problems (he was used to litter boxes with lids, but we placed a litter box without a lid in his cage). By days 4-5 he had his walk down (a cute hybrid of a cat/bunny walk) and was even running (he loves his food!). As Artie got more used to walking on three legs, we would let him stay out of the cage for longer periods of time (as long as he wasn’t too active and when we were able to supervise him).

After 10 days, Artie’s stitches were removed, and we were given the okay to release Artie from his “recovery condo" (even when we weren’t able to monitor him). We did keep Artie confined to one room when we weren't around to watch him and at night until we were confident that he (and the other cats) was comfortable. The confinement period only lasted for a couple of days. We were also told that as long as Artie didn’t lick his scabs too much, he didn’t need to wear the onesies. Artie tends to be an over-cleaner in general, so we weren’t really surprised that he immediately started in on the scabs. We did put a onesie on him the first night (when we weren’t able to monitor him), but we didn’t have to put the onesies on him after that night.

Post-Op Day 1

Post-Op Day 4

Post-Op Day 5

Post-Amputation ConcernsOn Artie’s first day home, his back twitched several times after he finished his lunch and drank his water. He quickly fell asleep on his stuffed rat a few minutes after that, and I never noticed any back twitches again.

On Artie’s second day home, I noticed there was still swelling by the area of amputation. I contacted another cat owner that I met through a website for cat owners. Her cat’s rear leg had been amputated earlier in the year. I asked her if her cat had any swelling after her amputation. I was relieved when she said that her cat had swelling and bruising for the first 48 hours. She had been instructed to use an “ice pack” for up to 20 minutes at a time twice a day. We tried this with Artie but he wouldn’t stay still. Despite having pain meds, Artie still acted like an active kitten!

By the third day, the swelling was down but I was worried that Artie had somehow pulled out some of his stitches. Artie would roll around on his back when he was happy or wrestling his stuffed rat and this would stretch the onesie out a bit and scoot it up. After doing some research online and looking at pictures, I realized that the area looked different because the swelling was down and I could see the individual stitches (when we first picked Artie up, we couldn’t see the actual stitches). Since the swelling was down, I sewed the neck holes tighter on all of the onesies and never had a problem with him scooting up the onesies again. He would occasionally lick the area of the onesie that covered the amputation site, but the onesies protected the stitches.

We have three other cats, so even though Artie was confined to a cage, I kept the door to that bedroom closed. Our oldest cat, Elvin, is very laid back but is usually very mean to any of his siblings after they come back from the vet office. I had planned on keeping Elvin away from Artie for the entire 10 days that Artie was confined to his cage. On the second day, though, Elvin slipped through my legs when I was entering Artie’s room. He ran over to the cage and I expected to hear a loud hiss/growl. To my surprise, Elvin didn’t display any aggression towards Artie. He seemed more curious about why Artie was in the cage. The next morning, he slept in the bed next to Artie's crate! His presence seemed to comfort Artie quite a bit, so I let him visit Artie whenever I was in the room. I also let his sister Hilda, who is very gentle, visit. Unfortunately Hetty Miep, our other female cat, hissed and swatted at Artie’s cage. So she wasn’t allowed to visit Artie.

Prior to the surgery, our vet told us that animals adapt very quickly to amputation and don't have the same attachment to the limbs or phantom limb pain that humans have. I was still worried about the adjustment period, though. Mostly about the psychological components: Would Artie be scared by what happened? Depressed? Angry at us? Nope! None of the above. He was his normal happy self. He was still our sweet boy—purring whenever we would first walk in the room or take him out of his cage. I did notice though that towards the end of Artie’s confinement (and after he had finished his pain meds), he seemed a bit depressed and/or bored (more subdued, not purring as much, and more brooding). He didn’t seem to be in pain and was as active as usual. He would also flop on his amputation site without any problems or signs of distress. My husband thought Artie had “cage syndrome.” Overall, these moments of depression didn’t last long and letting him out of the cage seemed to help quite a bit.

Artie & Elvin

Removal of Stitches

Post-Amputation AdjustmentsI read that some cats were unable to use covered litter boxes after an amputation. We had been using covered litter boxes. While Artie was in his recovery condo and confined to one room, we switched to an uncovered litter box for him. Once he had the full run of the house, though, we noticed that he preferred to use the covered litter boxes and he didn’t have a problem using them. Covered littered boxes may be more of an issue for cats with back leg amputations.

Artie did have to adjust to rolling around in his favorite sun spot. Instead of rolling from side to side, Artie would keep rolling like a rolling pin out of control. He eventually learned to redistribute his body weight so that he is now able to control his side-to-side roll. Sometimes when Artie is playing or batting at things, his stump twitches but I haven’t seen him try to consciously use it at all. He doesn’t seem to miss that arm.

Artie’s amputation didn’t seem to bother any of the other cats except for Hetty Miep (our alpha cat). It took her a bit of time to re-adjust to Artie, but she now tolerates Artie and has even been caught snuggling with him on a blanket.

OutcomesAs far as Artie is concerned, he is 100% and ready for anything. Artie loves his food, so we have to monitor his intake closely. Whether it is a front- or rear-leg amputation, it is important to maintain a healthy weight for amputees, since they do not have an extra leg to balance the weight over.

I’m happy to report that I haven’t noticed any signs of pain or discomfort in Artie. Quite the opposite. My husband thinks Artie is moving around better now than he did with his disabled leg. I think he experienced more discomfort than we’d realized, and that bad leg really slowed him down. Now he can run as fast as his four-legged siblings and is frequently spotted chasing them. He just turned one but still has crazy kitten energy. Maybe he is making up for lost time. Unfortunately, since Artie is feeling so much better, he sometimes plays too rough with Elvin (who has IBD), which stresses Elvin out. To keep things calm, I put Artie in “his” room (back bedroom full of windows and comfy cat beds with blankets) to give Elvin and the other cats a break when needed. While viewing videos (on YouTube) of other cats with front leg amputations, I realized that Artie’s walk is a bit different. They all do a bit of a bunny hop when they walk, but unlike the other front leg amputees, Artie still hunches over (front shoulders close to the ground with his bottom up in the air) the entire time he walks/hops.

I think this is because he learned to assume a hunched over position when he had the bad front leg and walked on his elbow. I am not sure if this difference will cause problems in the future, but he is much happier and healthier since the amputation.

I know other pet owners struggle with the difficult decision of amputation. It seems like a cruel decision to make, but in most of the cases, this is a life-saving decision (with the alternatives being constant pain, the inability to use a damaged limb, and/or the spread of cancer/infection). I wouldn’t hesitate to recommend amputation in these situations. Cats are able to not only survive but also thrive with only three legs.